Boxing Nova Scotia

Expense Refund Claim

Event:______________________________________                  Date:___________________________

Location: ______________________________________________________

Transportation – Receipts Required

Air Fare:                  $______________

Car Mileage:          57C X _________ KM = $____________

Vehicle Rental: $______________

Taxi/Bus:                $______________

Accommodations – Receipt Required

Hotel:                      $_______________

Meal Allowance

Breakfast:               $12.00 X _________ DAYS = $ ____________

Lunch:                     $20.00 X _________ DAYS = $ ____________

Supper:                   $30.00 X _________ DAYS = $____________

Other Expenses – Receipts Required

Parking:                  $______________

Phone:                    $______________

Internet:                 $______________

Total Claim:           $_____________

Name: _____________________________                            Position: _______________________________

Address: _____________________________________________________________________________________

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